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1.
Cardiovasc Ther ; 2022: 8317011, 2022.
Article in English | MEDLINE | ID: mdl-35495414

ABSTRACT

Aim: Colchicine as an anti-inflammatory drug might be effective in the treatment of atherosclerosis, an inflammatory-based condition. The aim of this systematic review and meta-analysis was to evaluate the impact of colchicine on acute coronary syndrome (ACS). Methods: We searched SCOPUS, PubMed, and Web of Science up to September 27, 2020. All clinical trials which evaluated the effect of colchicine on ACS patients and reported high-sensitivity C-reactive protein (hs-CRP) serum level or gastrointestinal (GI) adverse events with at least 5-day follow-up or death, myocardial infarction (MI), and stroke with at least 30-day follow-up as outcomes were included. Results: Finally, seven publications were analyzed. The results of our study revealed that colchicine has a marginally significant effect on hs-CRP attenuation. Furthermore, colchicine manifested promising results by declining the risk of stroke by 70%. However, MI and primary composite endpoint did not differ between the colchicine and noncolchicine groups. Although colchicine did not significantly increase GI adverse events in the pooled analysis, the dose-dependent effect was detected. Low-dose consumption can avoid GI side effects of colchicine. Conclusion: Colchicine has shown some molecular and clinical promising results in ACS patients. The lack of effect of colchicine on MI and all-cause mortality can be partly attributed to the limitations of previous studies. Since colchicine is an inexpensive and easy-to-access drug that has shown to be safe in low-dose regimens in the clinical setting; it would be worthy that future large-scale well-designed clinical trials address this issue by resolving the limitations of previous investigations.


Subject(s)
Acute Coronary Syndrome , Myocardial Infarction , Stroke , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/drug therapy , C-Reactive Protein , Colchicine/adverse effects , Humans , Stroke/diagnosis , Stroke/prevention & control
2.
Eur J Neurol ; 29(3): 905-909, 2022 03.
Article in English | MEDLINE | ID: mdl-34808013

ABSTRACT

BACKGROUND AND PURPOSE: A sensitive and frequent clinical sign of a vestibular tone imbalance is the tilt of the perceived subjective visual vertical (SVV). There are no data yet focusing on lesion location at the cortical level as a factor for predicting compensation from the tilt of the SVV. METHODS: With modern voxelwise lesion behavior mapping analysis, the present study determines whether lesion location in 23 right-hemispheric cortical stroke patients with an otolith dysfunction could predict the compensation of a vestibular tone imbalance in the chronic stage. RESULTS: Our statistical anatomical lesion analysis revealed that lesions of the posterior insular cortex are involved in vestibular otolith compensation. CONCLUSION: The insular cortex appears to be a critical anatomical region for predicting a tilt of the SVV as a chronic disorder in stroke patients.


Subject(s)
Otolithic Membrane , Stroke , Cerebral Cortex/pathology , Humans , Otolithic Membrane/pathology , Stroke/complications , Stroke/diagnostic imaging , Stroke/pathology
3.
J Korean Med Sci ; 37(7): e54, 2022 Feb 21.
Article in English | MEDLINE | ID: mdl-35191231

ABSTRACT

BACKGROUND: The code stroke system is designed to identify stroke patients who may benefit from reperfusion therapy. It is essential for emergency physicians to rapidly distinguish true strokes from stroke mimics to activate code stroke. This study aimed to investigate the clinical and neurological characteristics that can be used to differentiate between stroke and stroke mimics in the emergency department (ED). METHODS: We conducted a retrospective observational study of code stroke patients in the ED from January to December 2019. The baseline characteristics and the clinical and neurological features of stroke mimics were compared with those of strokes. RESULTS: A total of 409 code stroke patients presented to the ED, and 125 (31%) were diagnosed with stroke mimics. The common stroke mimics were seizures (21.7%), drug toxicity (12.0%), metabolic disorders (11.2%), brain tumors (8.8%), and peripheral vertigo (7.2%). The independent predictors of stroke mimics were psychiatric disorders, dizziness, altered mental status, and seizure-like movements, while current smoking, elevated systolic blood pressure, atrial fibrillation on the initial electrocardiogram, hemiparesis as a symptom, and facial palsy as a sign suggested a stroke. In addition, the likelihood of a stroke in code stroke patients tended to increase as the number of accompanying deficits increased from the following set of seven focal neurological deficits: hemiparesis (or upper limb monoparesis), unilateral limb sensory change, facial palsy, dysarthria, aphasia (or neglect), visual field defect, and oculomotor disorder (P < 0.001). CONCLUSION: Some clinical and neurological characteristics have been identified to help differentiate stroke mimics from true stroke. In particular, the likelihood of stroke tended to increase as the number of accompanying focal neurological deficits increased.


Subject(s)
Stroke , Thrombolytic Therapy , Diagnosis, Differential , Dizziness/complications , Dizziness/etiology , Emergency Service, Hospital , Humans , Retrospective Studies , Stroke/complications , Stroke/diagnosis , Stroke/drug therapy
4.
Eur J Neurol ; 29(3): 698-706, 2022 03.
Article in English | MEDLINE | ID: mdl-34797599

ABSTRACT

BACKGROUND AND PURPOSE: The causal effect of insulin resistance on small vessel stroke and Alzheimer's disease (AD) was controversial in previous studies. We therefore applied Mendelian randomization (MR) analyses to identify the causal effect of insulin resistance on small vessel stroke and AD. METHODS: We selected 12 single-nucleotide polymorphisms (SNPs) associated with fasting insulin levels and five SNPs associated with "gold standard" measures of insulin resistance as instrumental variables in MR analyses. Summary statistical data on SNP-small vessel stroke and on SNP-AD associations were derived from studies by the Multi-ancestry Genome-Wide Association Study of Stroke consortium (MEGASTROKE) and the Psychiatric Genomics Consortium-Alzheimer Disease Workgroup (PGC-ALZ) in individuals of European ancestry. Two-sample MR estimates were conducted with inverse-variance-weighted, robust inverse-variance-weighted, simple median, weighted median, weighted mode-based estimator, and MR pleiotropy residual sum and outlier (MR-PRESSO) methods. RESULTS: Genetically predicted higher insulin resistance had a higher odds ratio (OR) of small vessel stroke (OR 1.23, 95% confidence interval [CI] 1.05-1.44, p = 0.01 using fasting insulin; OR 1.25, 95% CI 1.07-1.46, p = 0.006 using gold standard measures of insulin resistance) and AD (OR 1.13, 95% CI 1.04-1.23, p = 0.004 using fasting insulin; OR 1.02, 95% CI 1.00-1.03, p = 0.03 using gold standard measures of insulin resistance) using the inverse-variance-weighted method. No evidence of pleiotropy was found using MR-Egger regression. CONCLUSION: Our findings provide genetic support for a potential causal effect of insulin resistance on small vessel stroke and AD.


Subject(s)
Alzheimer Disease , Insulin Resistance , Stroke , Alzheimer Disease/complications , Alzheimer Disease/genetics , Genome-Wide Association Study , Humans , Insulin Resistance/genetics , Mendelian Randomization Analysis , Polymorphism, Single Nucleotide/genetics , Stroke/complications , Stroke/genetics
5.
Front Endocrinol (Lausanne) ; 13: 869980, 2022.
Article in English | MEDLINE | ID: mdl-35518929

ABSTRACT

Background: Primary aldosteronism (PA) is the most common cause of secondary hypertension, and patients are at an increased risk of atrial fibrillation (AF) and stroke. We assessed the prevalence of PA in patients with recent stroke. Methods: We recruited 300 patients admitted to an acute stroke unit with diagnosis of cerebrovascular accident (haemorrhagic/ischaemic) or transient ischaemic attack. Three months post-stroke, plasma renin and aldosterone were measured. Patients with an elevated aldosterone-renin ratio proceeded to the confirmatory saline loading test. Results: Twenty-six of 192 (14%) patients had an elevated aldosterone-renin ratio. Three of 14 patients who proceeded to saline loading were confirmed with PA (post-saline aldosterone >138 pmol/l). Another three patients were classified as confirmed/likely PA based on the markedly elevated aldosterone-renin ratio and clinical characteristics. The overall prevalence of PA amongst stroke patients with hypertension was 4.0% (95% confidence interval (CI): 0.9%-7.1%). Prevalence of PA was higher amongst patients with cardioembolic stroke, 11% (95% CI: 1.3%-33%), resistant hypertension, 11% (95% CI: 0.3%-48%), and hypertension and AF, 30% (95%CI: 6.7%-65%). If only young patients or those with hypokalaemia were screened for PA, half of our patients with PA would not have been diagnosed. Our decision tree identified that stroke patients with AF and diastolic blood pressure ≥83mmHg were most likely to have PA. Conclusion: We found that amongst hypertensive patients with stroke, PA was more prevalent in those with AF, or cardioembolic stroke. Screening for PA should be considered for all patients with stroke.


Subject(s)
Atrial Fibrillation , Embolic Stroke , Hyperaldosteronism , Hypertension , Stroke , Aldosterone , Atrial Fibrillation/complications , Atrial Fibrillation/epidemiology , Humans , Hyperaldosteronism/complications , Hyperaldosteronism/epidemiology , Hypertension/complications , Hypertension/epidemiology , Renin , Stroke/complications , Stroke/epidemiology
6.
Pan Afr Med J ; 41: 132, 2022.
Article in English | MEDLINE | ID: mdl-35519168

ABSTRACT

Stroke is a major cause of disability and mortality among the Nigerian general population and thought to be commoner after the fifth decade of life and usually driven by conventional risk factors which are mainly cardio metabolic. However, with the youthful population in a city such as Abuja, stroke could be a mode of presentation of HIV in young people who are also more sexually active. Methods. This is a case series, reporting four cases of HIV positive young Nigerians with stroke. Patients´ data were retrieved from ward admissions records. The patients here had their socio-demographic data taken. They had presented with documented varied clinical features including those suggestive of stroke, after which they had HIV screening done which returned positive. One thousand four hundred and eighty-seven (1487) patients, were admitted in the medical ward, over a three-year period. Female to male ratio of 1:1 in the HIV-positive group, with an age range of 32 to 42 years and an average age of 37.5 years. Stroke constituted 5.7% of all admissions, with stroke in the young accounting for 1.2%. Of all stroke cases, stroke in the young constituted 21.43%, with those who were HIV positive accounting for 4.8%. Young people with stroke should be offered an HIV screening test.


Subject(s)
HIV Infections , Stroke , Adolescent , Adult , Female , HIV Infections/complications , HIV Infections/diagnosis , HIV Infections/epidemiology , Hospitalization , Humans , Male , Nigeria/epidemiology , Risk Factors , Stroke/epidemiology , Stroke/etiology
7.
Clin Interv Aging ; 17: 653-664, 2022.
Article in English | MEDLINE | ID: mdl-35520948

ABSTRACT

Objective: Type 2 diabetes mellitus (T2DM) and ischemic stroke, which are common diseases among older people, are closely related to cognitive impairment. This study aims to investigate the influencing factors of post-stroke cognitive impairment (PSCI) in patients with T2DM. Methods: We enrolled 161 patients with T2DM who experienced acute ischemic stroke and were hospitalized in the Department of Neurology, Jinan Central Hospital, Shandong, China. Cognitive function was evaluated with the Montreal Cognitive Assessment scale. According to the results, patients were divided into three groups-the cognitively normal group, mild cognitive impairment group, and severe cognitive impairment group. We analyzed general demographic data, laboratory information, imaging data, the results of neuropsychological evaluation, and clinical features as well as influencing factors of PSCI in these patients and established a prediction model. Results: The three groups of patients were significantly different in terms of age, education level, course of diabetes mellitus (DM), recurrent cerebral infarction (RCI), and other factors. RCI, course of DM, and glycated hemoglobin (HbA1c) were independent risk factors of PSCI in patients with T2DM, with odds ratio (95% confidence interval): 7.17 (2.09, 30.37), 5.39 (2.40, 14.59), and 3.89 (1.66, 10.04), respectively, whereas female, senior high school, serum albumin were protective factors: 0.28 (0.07, 0.95), 0.05 (0.01, 0.21), 0.20 (0.08, 0.42), respectively. Furthermore, we constructed a prediction model using sex, age, education level, RCI, DM course, HbA1c and serum albumin and obtained a receiver operating characteristic (ROC) curve. The area under the ROC curve is 0.966, suggesting the significant association of these influencing factors with PSCI in patients with T2DM. Conclusion: In this study, the occurrence of PSCI in patients with T2DM was related to RCI, course of DM, and HbA1c, among other factors. Attention to influencing factors is needed in these patients for early diagnosis and timely intervention of cognitive impairment.


Subject(s)
Cognitive Dysfunction , Diabetes Mellitus, Type 2 , Ischemic Stroke , Stroke , Aged , Cognitive Dysfunction/diagnosis , Diabetes Mellitus, Type 2/complications , Female , Glycated Hemoglobin A , Humans , Serum Albumin , Stroke/complications , Stroke/epidemiology
8.
J Neuroeng Rehabil ; 19(1): 44, 2022 May 07.
Article in English | MEDLINE | ID: mdl-35525970

ABSTRACT

BACKGROUND: Individuals with hemiparesis post-stroke often have difficulty with tasks requiring upper extremity (UE) intra- and interlimb use, yet methods to quantify both are limited. OBJECTIVE: To develop a quantitative yet sensitive method to identify distinct features of UE intra- and interlimb use during task performance. METHODS: Twenty adults post-stroke and 20 controls wore five inertial sensors (wrists, upper arms, sternum) during 12 seated UE tasks. Three sensor modalities (acceleration, angular rate of change, orientation) were examined for three metrics (peak to peak amplitude, time, and frequency). To allow for comparison between sensor data, the resultant values were combined into one motion parameter, per sensor pair, using a novel algorithm. This motion parameter was compared in a group-by-task analysis of variance as a similarity score (0-1) between key sensor pairs: sternum to wrist, wrist to wrist, and wrist to upper arm. A use ratio (paretic/non-paretic arm) was calculated in persons post-stroke from wrist sensor data for each modality and compared to scores from the Adult Assisting Hand Assessment (Ad-AHA Stroke) and UE Fugl-Meyer (UEFM). RESULTS: A significant group × task interaction in the similarity score was found for all key sensor pairs. Post-hoc tests between task type revealed significant differences in similarity for sensor pairs in 8/9 comparisons for controls and 3/9 comparisons for persons post stroke. The use ratio was significantly predictive of the Ad-AHA Stroke and UEFM scores for each modality. CONCLUSIONS: Our algorithm and sensor data analyses distinguished task type within and between groups and were predictive of clinical scores. Future work will assess reliability and validity of this novel metric to allow development of an easy-to-use app for clinicians.


Subject(s)
Stroke Rehabilitation , Stroke , Adult , Humans , Paresis/etiology , Reproducibility of Results , Stroke/complications , Upper Extremity
9.
Comput Math Methods Med ; 2022: 5435207, 2022.
Article in English | MEDLINE | ID: mdl-35529256

ABSTRACT

It is important to study the evaluation algorithm for the stroke rehabilitation treatment effect to make accurate evaluation and optimize the stroke disease treatment plan according to the evaluation results. To address the problems of poor restoration effect of positron emission tomography (PET) image and recognition restoration effect of evaluation data and so on. In the paper, we propose a stroke rehabilitation treatment effect evaluation algorithm based on cross-modal deep learning. Magnetic resonance images (MRI) and PET of stroke patients were collected as evaluation data to construct a multimodal evaluation dataset, and the data were divided into positive samples and negative samples. According to the mapping relationship between MRI and PET, three-dimensional cyclic adversarial is used to generate the neural network model to recover the missing PET data. Using the cross-modal depth learning network model, the RGB image, depth image, gray image, and normal images of MRI and PET are taken as the feature images and the multifeature fusion method is used to fuse the feature images, output the recognition results of MRI and PET, and evaluate the effect of stroke rehabilitation treatment according to the recognition results. The results show that the proposed algorithm can accurately restore PET images, the evaluation data recognition effect is good, and the evaluation data recognition accuracy is higher than 95%. The evaluation accuracy of stroke rehabilitation treatment effect is high, the evaluation time varies between 0.56 s and 0.91 s, and the practical application effect is good.


Subject(s)
Deep Learning , Stroke Rehabilitation , Stroke , Algorithms , Humans , Image Processing, Computer-Assisted/methods , Magnetic Resonance Imaging/methods , Positron-Emission Tomography/methods , Stroke/diagnostic imaging
10.
Zhongguo Zhong Yao Za Zhi ; 47(8): 2028-2037, 2022 Apr.
Article in Chinese | MEDLINE | ID: mdl-35531718

ABSTRACT

Precious Tibetan medicine formula is a characteristic type of medicine commonly used in the clinical treatment of central nervous system diseases. Through the summary of modern research on the precious Tibetan medicine formulas such as Ratnasampil, Ershiwuwei Zhenzhu Pills, Ershiwewei Shanhu Pills, and Ruyi Zhenbao Pills, it is found that they have obvious advantages in the treatment of stroke, Alzheimer's disease, epilepsy, angioneurotic headache, and vascular dementia. Modern pharmacological studies have shown that the mechanisms of precious Tibetan medicine formulas in improving central nervous system diseases are that they promote microcirculation of brain tissue, regulate the permeability of the blood-brain barrier, alleviate inflammation, relieve oxidative stress damage, and inhibit nerve cell apoptosis. This review summarizes the clinical and pharmacological studies on precious Tibetan medicine formulas in prevention and treatment of central nervous system diseases, aiming to provide a reference for future in-depth research and innovative discovery of Tibetan medicine against central nervous diseases.


Subject(s)
Central Nervous System Diseases , Stroke , Blood-Brain Barrier , Brain , Humans , Medicine, Tibetan Traditional , Stroke/drug therapy
11.
BMC Health Serv Res ; 22(1): 594, 2022 May 03.
Article in English | MEDLINE | ID: mdl-35505404

ABSTRACT

BACKGROUND: There is a lack of knowledge about patients' journeys across the stroke care continuum, especially regarding the transition from inpatient to outpatient care and rehabilitation. Therefore, the aim of the present study was to explore and describe patterns of healthcare use over a one-year period, health outcomes at 3 and 12 months for patients following a referral-based transition to subsequent rehabilitation in the home, and the caregiver burden on their significant others. A further aim was to explore factors associated with the use of rehabilitation and healthcare after the referral-based transition to continued rehabilitation in the home for people recovering from a stroke. METHODS: Data regarding healthcare use during the first 12 months post-stroke was collected from the Region Stockholm computerized register. Data on patient characteristics, disease-related data, and functioning were retrieved drawn from medical records and questionnaires. Descriptive statistics were used to present healthcare use, participants' characteristics, disease-related data, and patient functioning. Multivariable regression models were created to explore associations between the total number of outpatient contacts, total visits with the neurorehabilitation team, and the independent variables. RESULTS: The mean age for the 190 participants was 73 years for men and 78 years for women. Twenty-one participants (11%) had an acute rehospitalization within 30 days after discharge, and 41 participants (21%) were re-hospitalized within 90 days. Twenty-two (12%) of the participants had no visits with the neurorehabilitation team, 73 (39%) participants had 1-3 visits, 57 (30%) had 4-16 visits, and 38 (20%) had ≥17 visits. Female sex and length of hospital stay were associated with a higher number of visits with the neurorehabilitation team. Living alone, higher self-rated recovery, and being able to walk independently were associated with a lower number of visits with the neurorehabilitation team. Female sex, having home help services before the stroke, longer length of hospital stay, and more comorbidities were associated with a higher number of outpatient contacts. CONCLUSIONS: The findings indicate that there is no generic pattern of healthcare use during the first-year post-stroke in patients receiving referral-based transition to continued rehabilitation in the home. The different patterns of healthcare use seemed to mirror the participants' level of functioning. However, there is a need to further investigate how follow-up and rehabilitation correspond to the needs of patients and their significant others in the short- and long-term perspective. TRIAL REGISTRATION: ClinicalTrials.gov , registration number: NCT02925871 . Date of registration: October 6, 2016.


Subject(s)
Stroke Rehabilitation , Stroke , Aged , Ambulatory Care , Delivery of Health Care , Female , Humans , Male , Referral and Consultation , Stroke/therapy
13.
Adv Gerontol ; 35(1): 134-139, 2022.
Article in Russian | MEDLINE | ID: mdl-35522119

ABSTRACT

The article presents data on the problem of ischemic heart disease, surgical myocardial revascularization, as well as the risk of developing acute cerebrovascular accident (ACVA) in elderly patients with coronary artery bypass grafting (CABG). The authors conducted a study to identify risk factors for the development of stroke in elderly patients. Predictors of ACVA development in the operational and early postoperative periods were identified. It has been proven that the time of extubation, an increase in PCO2 levels, and hyperlactatemia are reliable intraoperative and early postoperative predictors of stroke in elderly patients with CABG. The practical significance of the study lies in the application of its results to predict the development of perioperative stroke in elderly patients with CABG.


Subject(s)
Coronary Artery Disease , Stroke , Aged , Coronary Artery Bypass/adverse effects , Coronary Artery Disease/surgery , Humans , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Period , Risk Factors , Stroke/diagnosis , Stroke/epidemiology , Stroke/etiology , Treatment Outcome
14.
JAMA Netw Open ; 5(5): e2210596, 2022 May 02.
Article in English | MEDLINE | ID: mdl-35522283

ABSTRACT

Importance: Promotion of clinician adherence to stroke guidelines can improve stroke outcomes. Objective: To investigate the outcomes of a multilevel system program on clinician adherence to guidelines for treatment of patients with acute ischemic stroke (AIS). Design, Setting, and Participants: This quality improvement study used a prospective interrupted time series (ITS) and difference-in-difference (DID) design, from August 1, 2018, to January 31, 2020, divided into preprogram term and short and long postprogram terms; each term had 6 months. Data were collected during hospitalization and at discharge with an automated medical record data capture system in 58 public hospitals in Zhejiang province, China. Data were analyzed from August 2018 to January 2020. Exposures: The multilevel system program included a modularized standard template for medical records, centrally supported continuing education, continuous monitoring and feedback, and collaborative workshops. Main Outcomes and Measures: The primary outcome was adherence to 12 key performance indicators (KPIs), expressed as (1) percentage of patient-applicable KPIs achieved in each participant and (2) percentage of participants among whom all applicable KPIs were achieved (dichotomous all-or-none measure). The secondary outcome was severe disability or death (modified Rankin Scale 5-6) at discharge. Results: Among 45 091 patients (mean [SD] age, 69 [12] years; 18 347 female [40.7%]), 28 721 from 30 hospitals received the program and 16 370 from 28 hospitals continued routine care. In adjusted DID analysis, the program was associated with an increase in the absolute percentage of KPIs achieved per patient (6.46%; 95% CI, 5.49% to 7.43%), absolute rate of all-or-none success (8.29%; 95% CI, 6.99% to 9.60%), and decreased rate of severe disability or death at discharge (-1.68%; 95% CI, -2.99% to -0.38%). The ITS result showed the program was associated with an increase in KPIs achieved per patient per week (slope change in short-term period, 0.36%; 95% CI, 0.20% to 0.52%; level change in long-term period, (9.64%; 95% CI, 4.58% to 14.69%) and in all-or-none success (slope change in short-term period 0.34%; 95% CI, 0.23% to 0.46%; level change in long-term period 5.89%; 95% CI, 0.19% to 11.59%). Conclusions and Relevance: The centrally supported program was associated with increases in clinician adherence to guidelines and reduced the proportion of severely disabled or deceased patients with AIS at discharge, providing support for its wider implementation.


Subject(s)
Ischemic Stroke , Stroke , Aged , Female , Hospitals , Humans , Ischemic Stroke/therapy , Male , Prospective Studies , Quality Improvement , Stroke/therapy
15.
PLoS One ; 17(5): e0268249, 2022.
Article in English | MEDLINE | ID: mdl-35522611

ABSTRACT

BACKGROUND: Sex differences in post-stroke cognitive decline have not been systematically evaluated in a nationally representative cohort. We use a quasi-experimental design to investigate sex differences in rate of post-stroke cognitive decline. METHODS: Utilizing the event study design, we use the Health and Retirement Study (HRS) data (1996-2016) to evaluate the differences (percentage points [95% Confidence interval]) in the rate of change in cognitive function, measured using the modified version of the Telephone Interview for Cognitive Status (TICS-m) score, before and after incident stroke, and among patients with and without incident stroke. We estimated this event study model for the overall study population and separately fit the same model for male and female participants. RESULTS: Of 25,872 HRS participants included in our study, 14,459 (55.9%) were females with an overall mean age (SD) of 61.2 (9.3) years. Overall, 2,911 (11.3%) participants reported experiencing incident stroke. Participants with incident stroke (vs. no stroke) had lower baseline TICS-m score (15.6 vs. 16.1). Among participants with incident stroke, the mean pre-stroke TICS-m score was higher than the mean post-stroke TICS-m score (14.9 vs. 12.7). Event study revealed a significant short-term acceleration of cognitive decline for the overall population (4.2 [1.7-6.6] percentage points, p value = 0.001) and among female participants (5.0 [1.7-8.3] percentage points, p value = 0.003). We, however, found no evidence of long-term acceleration of cognitive decline after stroke. Moreover, among males, incident stroke was not associated with significant changes in rate of post-stroke cognitive decline. CONCLUSION: Females, in contrast to males, experience post-stroke cognitive deficits, particularly during early post-stroke period. Identifying the sex-specific stroke characteristics contributing to differences in post stroke cognitive decline may inform future strategies for reducing the burden of post-stroke cognitive impairment and dementia.


Subject(s)
Cognitive Dysfunction , Stroke , Cognition , Cognitive Dysfunction/epidemiology , Cognitive Dysfunction/etiology , Female , Humans , Longitudinal Studies , Male , Middle Aged , Sex Characteristics , Stroke/complications , Stroke/epidemiology , Stroke/psychology
17.
Tidsskr Nor Laegeforen ; 142(7)2022 05 03.
Article in Norwegian | MEDLINE | ID: mdl-35510464

ABSTRACT

Mechanical thrombectomy is now the standard treatment for acute ischaemic stroke with occlusion of a carotid or intercranial artery. With occlusions of this type, thrombolytic treatment often has limited effect. The therapeutic outcome with the use of thrombectomy is time-dependent, and a personalised approach to indication is always necessary. To achieve the best possible results, the main prerequisites are good clinical procedures, an optimal patient pathway, high neuroradiological competence and coordinated, interdisciplinary teams.


Subject(s)
Brain Ischemia , Endovascular Procedures , Stroke , Acute Disease , Brain Ischemia/diagnostic imaging , Brain Ischemia/surgery , Cerebral Infarction , Humans , Retrospective Studies , Stents , Stroke/diagnostic imaging , Stroke/surgery , Thrombectomy/methods , Treatment Outcome
18.
PLoS One ; 17(5): e0267837, 2022.
Article in English | MEDLINE | ID: mdl-35511879

ABSTRACT

OBJECTIVES: Pial collateral blood flow is a major determinant of the outcomes of acute ischemic stroke. This study was undertaken to determine whether retinal vessel metrics can predict the pial collateral status and stroke outcomes in patients. METHODS: Thirty-five patients with acute stroke secondary to middle cerebral artery (MCA) occlusion underwent grading of their pial collateral status from computed tomography angiography and retinal vessel analysis from retinal fundus images. RESULTS: The NIHSS (14.7 ± 5.5 vs 10.1 ± 5.8, p = 0.026) and mRS (2.9 ± 1.6 vs 1.9 ± 1.3, p = 0.048) scores were higher at admission in patients with poor compared to good pial collaterals. Retinal vessel multifractals: D0 (1.673±0.028vs1.652±0.025, p = 0.028), D1 (1.609±0.027vs1.590±0.025, p = 0.044) and f(α)max (1.674±0.027vs1.652±0.024, p = 0.019) were higher in patients with poor compared to good pial collaterals. Furthermore, support vector machine learning achieved a fair sensitivity (0.743) and specificity (0.707) for differentiating patients with poor from good pial collaterals. Age (p = 0.702), BMI (p = 0.422), total cholesterol (p = 0.842), triglycerides (p = 0.673), LDL (p = 0.952), HDL (p = 0.366), systolic blood pressure (p = 0.727), HbA1c (p = 0.261) and standard retinal metrics including CRAE (p = 0.084), CRVE (p = 0.946), AVR (p = 0.148), tortuosity index (p = 0.790), monofractal Df (p = 0.576), lacunarity (p = 0.531), curve asymmetry (p = 0.679) and singularity length (p = 0.937) did not differ between patients with poor compared to good pial collaterals. CONCLUSIONS: This is the first translational study to show increased retinal vessel multifractal dimensions in patients with acute ischemic stroke and poor pial collaterals. A retinal vessel classifier was developed to differentiate between patients with poor and good pial collaterals and may allow rapid non-invasive identification of patients with poor pial collaterals.


Subject(s)
Brain Ischemia , Ischemic Stroke , Stroke , Brain Ischemia/diagnostic imaging , Cerebral Angiography/methods , Collateral Circulation/physiology , Humans , Infarction, Middle Cerebral Artery , Retinal Vessels/diagnostic imaging , Retrospective Studies , Stroke/diagnostic imaging
19.
Medicine (Baltimore) ; 101(17): e29167, 2022 Apr 29.
Article in English | MEDLINE | ID: mdl-35512073

ABSTRACT

ABSTRACT: This article was to analyze the factors influencing the prognosis of posterior circulation cerebral infarction (PCCI) patients, retrospectively.One hundred forty five patients diagnosed with PCCI in Nanyang Central Hospital between June 25, 2016 and October 14, 2019 were included and underwent cerebral vascular mechanical thrombectomy. The clinical data of those patients were collected. The patients were followed up for 3 months to observe the prognostic efficacy and explore the influencing factors for poor prognosis. The potential prognostic factors for PCCI patients after emergency endovascular mechanical thrombectomy were analyzed by univariate and multivariable logistic regression. The thermodynamic diagram was drawn to explore the associations between the prognostic factors.The risk of poor prognosis in PCCI patients receiving emergency endovascular mechanical thrombectomy was reduced by 0.552 time with every 1-point increase of the Alberta Stroke Program Early CT in posterior circulation score (odds ratio [OR] = 0.448, 95% confidence interval [CI]: 0.276-0.727). The risk of poor prognosis was increased by 0.827 time for each additional grade in the digital subtraction angiography-American Society of Intervention and Therapeutic Neuroradiology grading (OR = 1.827, 95% CI: 1.221-2.733, P = .003) and increased by 0.288 time for every 1-point increase in National Institutes of Health Stroke scale at 24 hours (OR = 1.288, 95% CI: 1.161-1.429). All P < .05.Alberta Stroke Program Early CT in posterior circulation score, digital subtraction angiography-American Society of Intervention and Therapeutic Neuroradiology grading, National Institutes of Health Stroke scale score at 24 hours were factors affecting the prognosis of PCCI patients undergoing emergency endovascular mechanical thrombectomy, which might provide evidence for endovascular treatment of PCCI.


Subject(s)
Brain Ischemia , Endovascular Procedures , Stroke , Cerebral Infarction/surgery , Humans , Prognosis , Retrospective Studies , Thrombectomy , Treatment Outcome
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